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Long-term Opioid Use for Chronic Pain
Although short-term use of opioids to treat acute pain appears to be effective, the rationale for long-term use (more than 90 days) of opioids for chronic pain is less compelling owing to well-known adverse effects, dependence, and risk of opioid overdose. In a population-based cohort study, Hoffman and coauthors tracked prescriptions for 1993 patients being treated for polyneuropathy, a common condition among elderly individuals, and found that those receiving long-term opioid therapy had greater rates of depression and dependence and lower self-ratings on functional status measures than controls. Editorial perspective is provided by Volkow and Koroshetz.
Continuing Medical Education
Prevalence of Cerebral Cavernous Malformations
The prevalence of cavernous malformations is unknown because many patients are nonsymptomatic, and current estimates are based on autopsy studies, which are subject to multiple biases. In this population-based longitudinal imaging study from the Mayo Clinic Study of Aging, Flemming and coauthors evaluated medical records and brain magnetic resonance imaging scans of 2715 participants aged 50 to 89 years. The prevalence of nonsymptomatic cavernous malformations was similar to the prevalence found in recent studies, but the frequency of symptomatic cavernous malformations was less than current autopsy studies estimate.
Blast Traumatic Brain Injury and 5-Year Outcomes
Although traumatic brain injury affects 3.5 million Americans each year, an estimated 20% of US military service members experience combat-related blast traumatic brain injury during deployment to Iraq and Afghanistan and then have higher rates of comorbid mental health conditions after traumatic brain injury compared with civilians. In this longitudinal case-control study, Mac Donald and coauthors observed 50 service members essentially from point of injury in combat and 44 combat-deployed, noninjured control individuals, examining functional trajectories and longitudinal outcomes following blast injury. Blast concussion patients faired far worse in mental health measures at 5 years compared with control individuals. Interestingly, 80% of patients endorsed seeking treatment and therapy, but only 18% experienced sustained resolution of symptoms. Editorial perspective is provided by Dams-O’Connor and Tsao.
Survival in Types of Syncleinopathies With Parkinsonism
Survival after a clinical diagnosis of parkinsonian α-synucleinopathies and the causes of death of patients compared with age-matched and sex-matched control individuals is not well understood in the general population. The Rochester Epidemiology Project medical records–linkage system was used to identify 461 patients with parkinsonism from 1991 through 2010 to determine the risk of death and cause of death compared with age-matched and sex-matched controls. Savica and coauthors reported that patients with clinically diagnosed synucleinopathies died a median of 2 years earlier than control patients. Patients with multiple system atrophy had the highest risk of death, followed by dementia with Lewy bodies, Parkinson disease dementia, and Parkinson disease. Other than neurodegenerative diseases, the most common causes of death listed in the death certificate for these patients were cardiovascular disorders.
Highlights. JAMA Neurol. 2017;74(7):755. doi:10.1001/jamaneurol.2016.4004
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